Provider Demographics
NPI:1003973538
Name:LUCENTE, PERRY J (OD)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:J
Last Name:LUCENTE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 HOWARD GROVE RD
Mailing Address - Street 2:
Mailing Address - City:DAVIDSONVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21035
Mailing Address - Country:US
Mailing Address - Phone:410-956-2594
Mailing Address - Fax:410-956-2594
Practice Address - Street 1:2510 HOWARD GROVE RD
Practice Address - Street 2:
Practice Address - City:DAVIDSONVILLE
Practice Address - State:MD
Practice Address - Zip Code:21035
Practice Address - Country:US
Practice Address - Phone:410-956-2594
Practice Address - Fax:410-956-2594
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2010-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1029152W00000X
VA0601001619152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD650898700Medicaid
MD656342OtherMEDICARE
DC656342OtherMEDICARE
MD650898700Medicaid
MD656342OtherMEDICARE